A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States

Abstract

Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.

Keywords: HIV; HIV testing; implementation science; linkage-to-care; men who have sex with men; preexposure prophylaxis.

Figure 1

Total diagnoses and deaths due to HIV, 1981–2019. Abbreviations: ART, antiretroviral therapy; IDU, injection drug use; MSM, gay, bisexual, other men who have sex with men; PrEP, pre-exposure prophylaxis. Data for diagnoses, 1981–2007 (modeled), are from CDC (2021a). Data for total deaths, 1981–2007, are from CDC (1999, 2007). All data for the period 2008–2019 were obtained from https://gis.cdc.gov/grasp/nchhstpatlas/tables.html using the following variables: HIV diagnoses, HIV deaths, national, 2008–2019, white, Black/African American, cisgender male, male-to-male sexual contact, injection drug use.

Figure 2

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram for new systematic reviews that included searches of databases and registers only. Abbreviations: MSM, gay, bisexual, other men who have sex with men; PrEP, pre-exposure prophylaxis.